Suppliers and contractors

Supplier delivers cheaper equipment and keeps the difference (Spain)

In almost 200 cases a company in Spain delivered cheaper wheelchairs of less performance than those actually prescribed by the specialist doctors and which were in fact reimbursed by CatSalut, the Catalan Health Service.   

In Catalonia, CatSalut provides a catalogue with all the orthopaedic services they finance; the prescriptions made by specialist doctors should be adapted to this catalogue. When patients receive the prescription they can go to any orthopaedia to look for the article.

In this case, patients went to the company with the prescription and the orthopaedist supplied them with a wheelchair. However the reference supplied did not correspond to the reference written on the prescription.  The orthopaedist supplied its patients with a cheaper wheelchair of less performance which corresponded to another reference. Once the patients signed the document confirming they had received the (more expensive) equipment the orthopaedist invoiced the article to CatSalut.

Since patients did not know the characteristics of the article prescribed and since noone checked if the article matched the reference in the prescription, this  fraudulent act affected almost 200 patients until it was discovered.

Suppliers and healthcare providers “earn” over €40,000 through fraudulent prescriptions (Spain)

Four doctors, four pharmacists and one pharmaceutical representative were involved in a case of fraudulent prescriptions that amounted to more than €40,000. The primary healthcare doctors wrote prescriptions in the name of elderly patients they had visited in the same primary healthcare centre. However no medicines were prescribed to any patients and no patient ever received them. Instead, the doctors would give the prescriptions to the pharmaceutical representative who would in turn fill in the prescriptions with high cost medicines produced by the laboratory he represented. The representative would then give the prescriptions to the pharmacists, who would then invoice the medicines to CatSalut, the Catalan Health Service. A total of 557 fraudulent prescriptions were found, representing an amount of €42.910,4.

Supplier "delivers" higher amounts of equipment and products (France)

A chemist invoiced the French health services for more than the products and equipment actually delivered.  The fraud was discovered as the turnover amount was unusually high, up to 5 times higher than the average of a chemist in that French “department” (province).

The pharmacist was known as «an expert for the delivery of equipment and products». Their services included home delivery, even to distant areas, of the most expensive equipment or products by a simple phone call; other products were delivered to local pharmacies. They approached their customers by intermediaries through prospecting and selling to hospital structures.

The chemist's invoices referred to services and equipment such as drug prescriptions for elderly people and full reimbursements for long-term diseases with important and expensive care for patients who did not have any private insurance. The invoices were processed in an unsecure manner where the chemist would systematically supply photocopies instead of original duplicates, which would contain corrections, additional prescription items, correction fluid over words, or additional repeat items. The pharmacy stamp was positioned in such a way that it would hide the quantities which had been altered.

The local health insurance's financial harm was assessed to €350,000 per year.

Supplier claims for unclear transport services (France)

A supplier introduced transport claims which were not in accordance with the law. These invoices concerned, among others:

• the simultaneous transport of several insured people, who had been invoiced individually and without the rebate that is foreseen by law in this case;
• transport performed by the company's manager who was on paid leave at those times (either on sickness leave or after a work accident).
• ambulance trips, which mentioned the registration number of an ambulance which was no longer operational.
• transports whose schedule had been altered in order to justify the additional charge for transport by night.

Additionally the employer failed to declare that the carrier he had employed for six years had taken or had been given early retirement. The financial harm was assessed to over €540,000.